2. AP PROJECTION
• LPO AND RPO POSITIONS
• LATERAL POSITION (OPTIONAL):
CYSTOGRAPHY
Pathology Demonstrated
Signs of cystitis, obstruction, vesicoureteral reflux, and
bladder calculi are visualized. Lateral demonstrates
possible fistulas between bladder and uterus or rectum.
Cystography
BASIC
• AP (CR 10° to 15° caudad)
• Both oblique positions (45° to 60°)
5. Posterior Oblique Positions:
• 45° to 60° body rotation. (Steep oblique positions are used to visualize
posterolateral aspect of bladder, especially UV junction.)
RPO (45° to 60°).
7. - RPO (30°) POSITION – MALE
- AP PROJECTION - FEMALE: VOIDING
CYSTOURETHROGRAPHY
Pathology Demonstrated
Functional study of the urinary bladder and urethra determines
cause of urinary retention and evaluates for possible
vesicoureteral reflux.
Voiding Cystourethrography
BASIC
• Male—RPO (30°)
• Female—AP
8. Male:
• Oblique body 30° into the RPO position.
• Superimpose urethra over soft tissues of right thigh.
9. Female:
• Position patient supine or erect into the AP position.
• Center midsagittal plane to table or film holder.
• Extend and slightly separate legs.
10. COMPRESSION
Compression
Distention
Release
Flow Full
Visualization of length
Normal peristalsis may leave portions of
ureters empty of contrast
To inhibit ureteric drainage and promote
distension of pelvicalyceal systems,
optimising visualization
Proximal ureters and intrarenal
collecting system optimally distended
With contraindications
11. 15-MINUTE
After compression is released, there is
transient increase in flow down the
ureters TAKE RADIOGRAPH
Peristalsis makes visualization of
entire length uncommon
Kidneys and ureters still visualized,
although less clearly
Bladder begins to light up
12. FULL BLADDER FILM
Bladder should appear smooth,
balloon-like, globular structure above
the pelvic rim
Kidneys, ureters less visible
13. FULL BLADDER FILM
Bladder should appear smooth,
balloon-like, globular structure above
the pelvic rim
Kidneys, ureters less visible
Ureters are compressed against pelvis
Place belt and pneumatic balloons at upper edge anterior superior iliac spine
Paddles should nearly meet at the midline
Contraindications:
Omitted in children
Aortic aneurysm
Ureteral obstruction
Acute abdominal/flank pain
Tender abdomen
Recent abdominal surgery
Abdominal stomas
Colostomy, ileostomy, ileal conduit
Obstruction lower down (ie pelvic portion of the ureters) may now be visualized
Ureters:
A full-length radiograph at this stage will best demonstrate the ureters. If there is any hold-up of contrast medium in a ureter, further views are indicated
prone view contrast medium will collect in a more dependent portion of the ureter
oblique view relationship of the ureter to a possible phlebolith will be seen
Bladder:
Bladder will be well filled at this stage
Oblique views may help to show any irregularity of the wall of the bladder or demonstrate the relationship of a pelvic mass to the bladder
As the bladder becomes progressively distended, the intraluminal contrast material should be spheric and smoothly marginated and the wall progressively less evident
NOTE:
contrast material–opacified urine is heavier than nonopacified urine. Gravity maneuvers such as imaging with the patient in the prone or dependent oblique position often assist with visualization of unopacified portions of the ureters, especially in cases of obstruction.
Supine: ureters are sometimes not seen because of inherent peristalsis
Prone: ureters are much seen because abdominal contents pushes the ureters anteriorly and blocks peristalsis
- If bladder is not found above pelvic rim, or appears to descend upon filling, a cystocoele should be considered
- If bladder is not found above pelvic rim, or appears to descend upon filling, a cystocoele should be considered
If bladder is not found above pelvic rim, or appears to descend upon filling, a cystocoele should be considered
Summary of Findings: Renal papilla cup shaped, no abnormal filling defects, pelvocalyces not dilated, ureters 3-5mm diameter, urinary bladder located above pelvic brim, moderately dilated with no filling defects
If bladder is not found above pelvic rim, or appears to descend upon filling, a cystocoele should be considered
Summary of Findings: Renal papilla cup shaped, no abnormal filling defects, pelvocalyces not dilated, ureters 3-5mm diameter, urinary bladder located above pelvic brim, moderately dilated with no filling defects
